Skin sarcoidosis treatment

Corticosteroids are the drug of choice for the treatment of skin sarcoidosis. Usually a dose of 20 to 40 mg of prednisone equivalent/day is used initially and the dose is tapered depending on the treatment effect and the development of corticosteroid side effects. 

Kaplan (1960) observed that colchicine may produce objective improvement in the periarthritis associated with sarcoidosis (presence of noncaseat-ing granulomas in tissue), Colchicine is sometimes used in llte treatment of scleroderma (deposition of fibrous connective tissues in skin or other organs) it may assist in preventing attacks of Mediterranean fever and it is sometimes used as part of drug therapy for some renal (kidney) diseases. 

Patients with sarcoidosis are intolerant of vitamin D possibly even to the tiny amoimt present in a normal diet, and to that synthesised in their skin by sunlight. The intolerance may be due to overproduction of calcitriol (see above) by macrophages activated by interferon the overproduction is reversed by corticosteroid, which is also used in the treatment of severe hypervitaminosis D (see below). 

Tumor necrosis factor alpha (TNF-a) is a cytokine that is secreted by macrophages associated with sarcoid granulomas (46). Antagonists of TNF-a including thalidomide (47), and infliximab (48) have been shown to be useful for the treatment of cutaneous sarcoidosis. Infliximab appears to be particularly useful for the treatment of lupus pernio (48). The use of infliximab is limited by its high cost and the need for intravenous administration. Fatal cases of tuberculosis have been associated with infliximab administration (49). Therefore, a tuberculin skin test is required prior to its use, and patients on the drug must be monitored closely for the development of tuberculosis. 

Paradoxical inflammation such as psoriasis is a well-known phenomenon of anti-TNFa therapy approved for the treatment of autoimmxme diseases such as rheumatoid arthritis, Crohn s disease, ulcerative colitis and psoriasis. Likewise, infliximab is used to treat refractory sarcoidosis but recently a case of infliximab-induced cutaneous sarcoidosis was reported in a patient with ulcerative colitis [150 ]. The induction of psoriasis and other clinical presentations like psoriasiform exanthema and palmoplantar pustulosis as side effects of infliximab treatment is not xmderstood and the pathogenesis of such reactions has been further obscured by the finding of a patient with Crohn s disease who developed arthritis as well as the skin manifestations cf psoriasis after the administration of infliximab [151 ]. 

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